IMPORTANT: Keep Your Provider Directory Information Current to Protect Your Network Status. Learn more

Safeguard Your Network Status

What are patients seeing when they look at your information in the Highmark provider directory?

Is your practice name correct? Are all practitioners listed?

xWe want Highmark members to have the most reliable information about your practice, so they are able to make informed decisions on where to seek care. That’s why it’s essential that the practice information you have on file with Highmark remains up to date and is attested to on a quarterly basis.

Providers who don’t validate and attest that their data is accurate will be immediately removed from the directory, and their status within Highmark’s networks may be impacted.

The Centers for Medicare & Medicaid Services (CMS) requires Highmark to conduct a quarterly outreach to validate provider information. We use this information to populate our provider directory and to help ensure correct claims processing.

Each review confirms:

  • The practitioner name is correct. For example, we must ensure the practitioner’s name in the directory matches the name on his/her medical license.
  • The practice name is correct. For example, is there a difference between the practice name that is being used when phones are answered versus the practice name listed in the directory?
  • The practitioner’s practicing specialties are correctly listed. Is there more than one specialty listed in the directory? Are both specialties being practiced?
  • Practitioners are not listed at practice locations where they don’t actually schedule appointments and see patients. Practitioners listed must be affiliated with the group. Practitioners who cover on an occasional basis are not required to be listed. Practitioners who do not see patients on a regular basis at a location should not be listed at that location.
  • The practitioner is accepting new patients — or not accepting new patients — at the location.
  • The practitioner’s address, suite number (if any), and phone number are correct.

It’s vital that all providers review and update their information in Provider File Management within NaviNet®. All fields should be completed with your up-to-date information, including your current address, phone number, and fax number. Information should be updated as soon as a change occurs. All data should be reviewed at a minimum of once a quarter to ensure it’s accurate. Detailed instructions are available in the Provider File Management NaviNet Guide, which is available on the Provider Resource Center under Education/Manuals.

Highmark and its designated agent, Atlas, are currently making outreach calls to providers to verify the accuracy of provider data. If you receive a call, please provide our agent with the requested information.

 

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